Emotional and Wellbeing Support Service Feedback Form

You have been sent this link if you recently completed Talking Therapy. We welcome and value compliments, complaints and suggestions about our services and our staff. This form is used to capture feedback on whether you are satisfied with the customer service received, the service(s) used and to tell us any improvements that we may need to make.

Thank you!

Name and Surname

Network this relates to

Please copy and paste the Network ID. This is a combination of letters and numbers provided by your facilitator. It looks like this: 0064J00000JdBoe

What has not worked? What would you change?

What didn't you like? What would you change?

If you feedback was about named staff are you happy for us to pass it on anonymously?

Yes

Over the last week, how often have you been bothered by any of the following problems?

Feeling nervous, anxious or on edge

0 - Not all all

1 - Several days

2 - More than half the days

3 - Nearly every day

Not being able to stop or control worrying

0 - Not all all

1 - Several days

2 - More than half the days

3 - Nearly every day

Feeling down, depressed, or hopeless

0 - Not at all

1 - Several days

2 - More than half the days

3 - Nearly every day

Little interest or pleasure in doing things

0 - Not at all

1 - Several days

2 - More than half the days

3 - Nearly every day